Constrictive Pericarditis Presenting as Bilateral Pleural Effusion: A Report of Two Cases

Constrictive pericarditis is a rare presentation. We need a very high index of clinical suspicion to diagnose the disease. It most commonly presents secondary to tuberculosis (TB) in the developing world and post-radiation therapy in the developed world. Classically, it presents with symptoms of heart failure and as pericardial thickening or calcification on imaging studies. In hospital settings, constrictive pericarditis is not usually considered as a differential in patients presenting with pleural effusion. According to the literature, associated pleural effusions in cases of constrictive pericarditis could be left-sided. Herein, we present two unusual presentations of cases with bilateral pleural effusions. One of our cases developed constrictive pericarditis with concurrent active tuberculosis. This is a rare presentation because, normally, constrictive pericarditis is a late complication of tuberculosis. We suggest that when dealing with cases of bilateral pleural effusion, the etiology of constrictive pericarditis should be considered

Predictive Factors of Suicide Attempt and Non-Suicidal Self-Harm in Emergency Department

Introduction: Suicide is the third cause of mortality in America, second leading cause of death in developed countries, and one of the major health problems. Self-harm is self-inflicted damage to one’s self with or without suicidal intent. In the present study, the predictive factors of suicide attempt and non-suicidal self-harm were evaluated in patients referred to emergency department (ED) with these problem. Methods: The total number of 45 patients with suicide attempt or self-harm admitted to ED were included. Clinical symptoms, thoughts and behaviors of suicidal, and non-suicidal self-harm in these patients were evaluated at baseline. Suicidality, suicidal intent and ideation, non-suicidal self-injury, social withdrawal, disruptive behavior, and poor family functions were evaluated at admission time. Brief clinical visits were scheduled for the twelfth weeks. In the twelfth week, patients returned for their final visit to determine their maintenance treatment. Finally data were analyzed using chi-squared and multiple logistic regression. Results: Forty five patients were included in the study (56.1% female). The mean age of patients was 23.3±10.2 years (range: 15-75; 33.3% married). Significant association of suicide and self-injury was presented at the baseline and in the month before attempting (p=0.001). The most important predictive factors of suicide and self-harm based on univariate analysis were depression (suicidal and non-suicidal items of Hamilton depression rating scale), anxiety, hopelessness, younger age, history of non-suicidal self-harm and female gender (p<0.05). The participants’ quality of life analysis showed a significant higher quality in physical component summary (p=0.002), mental component summary (p=0.001), and general health (p=0.001) at follow up period. Conclusion: At the time of admission in ED, suicide attempt and non-suicidal self-harm are subsequent clinical markers for the patient attempting suicide again. The most independent predictive factors of suicide attempt and self-harm were poor family function, hopelessness, non-suicidality items of Hamilton depression rating scale, history of non-suicidal self-harm, and anxiety disorders

ANALISIS DAMPAK MEKANISME PENERIMAAN SISWA BARU BERDASARKAN UMUR DI INDONESIA KHUSUSNYA DI JAKARTA

New Student Admission is a series of annual compulsory activities held by all schools in Indonesia in order to accept new students in the new academic year. The process of New Student Admission is based on school and government policies. In 2019, the Ministry of Education and Culture issued a regulation regarding the admission of new students as stipulated in the Regulation of the Minister of Education and Culture Number 44 of 2019. In this regulation, the age of students is used as one of the parameters that are put into consideration after the distance between residence. In its implementation, many schools in Jakarta use age as the main parameter instead of the distance of student residence so that it violates the provisions of Permendikbud 44 of 2019. The use of age as a main parameter can affect student achievement in school. To see this further, a literature study was conducted which discussed the effect of entry age and achievement in several countries and various levels of education. Based on the literature that has been done, it is unfortunate that the effect of student entry age on achievement at school has different results between each level of education. At the early education level (Kindergarten - Elementary School), the age at which students enter has an influence on their achievement at school, but this does not apply at the secondary level (Junior High School - Senior High School) where the age of students has no effect on achievement at school.

Serial Magnetic Resonance Imaging in Creutzfeldt-Jakob Disease: a Case Report and Literature Review

Creutzfeldt-Jakob disease (CJD) is a rare, degenerative, invariably fatal brain disorder. CJD usually appears in later life and runs a rapid course. Typically, the onset of symptoms occurs about age 60 and about 90% of individuals die within one year. We report a case of 67-year-old male presented with progressive aphasia, confusion, dysphagia and inability to carry out activities of daily life (ADLs) over a period of three to four weeks. The patient had past medical history of chronic atrial fibrillation and hypertension. Prior to admission, the patient was treated for ischemic stroke of left basal ganglia but continued to have worsening encephalopathy. The spinal tap revealed a 14-3-3 protein level of thirteen times the upper limit of normal; electroencephalogram (EEG) showed a diffuse slowing of the background and periodic sharp waves with greater involvement of the left hemisphere. Diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) at the time of admission showed extensive signal abnormality in the basal ganglia bilaterally and in the cerebral cortex bilaterally, particularly over the left cerebral hemisphere. The persistence of the MRI findings over several weeks was concerning for spongiform encephalopathy. The probable diagnosis of Creutzfeldt-Jakob disease was made based on these imaging findings taken together with the patient’s clinical signs and symptoms of a rapidly progressive encephalopathy. The patient was able to have some quality time with his family as the diagnosis was made earlier than perhaps otherwise and expired peacefully after comfort care measures were chosen. Serial MRI may serve as a clue to the early diagnosis of CJD and potentially provide a better quality of life for the patients

Parental Role in Recognition, Prevention and First Aid Management of Foreign Body Aspiration amongst Children

Background: Foreign body aspiration (FBA) is a commonly observed, fatal but preventable condition in children. To reduce the incidence of FBA, it is essential to provide parents with knowledge and guidelines regarding the prevention and management of FBA. Objectives: To assess parental knowledge and parental role in the prevention and first aid management of foreign body aspiration in children. Methods: A descriptive cross-sectional study was carried out at Mayo Hospital, Lahore from January 2019 to September 2019. After IRB approval and informed consent, 151 parents were enrolled through convenient sampling. Data were recorded in a structured questionnaire and analyzed through SPSS version 26. Results: Breathlessness and vomiting were recognized as symptoms of FBA by 49.7% & 7.3% of parents respectively. Hand clutched to throat, color & voice change were recognized as signs by 6.6 %, 9.9 % &10.6 % of the parents. As a first aid measure, 66.2% of individuals knew about back slaps, while only 2% were aware of abdominal thrusts. Literate parents were well aware of the facts that children under the age of three should not consume seeds, hazelnuts, and hard nuts and the child should not laugh or talk while eating compared to illiterate parents (p<0.05) Conclusion: The majority of the parents are not well aware of signs, symptoms, preventive measures and first aid measurements regarding FBA

Recurrent Graves’ hyperthyroidism after prolonged radioiodine-induced hypothyroidism

Background: Radioactive iodine (RAI) is the most cost effective therapy for Graves’ disease (GD). Patients with GD who have become hypothyroid after therapeutic RAI, rarely develop recurrence of disease. Herein we describe a case of recurrence of thyrotoxicosis after 2 years of hypothyroidism. Methods: We present the clinical features, laboratory findings, imaging and management of an unusual case of recurrent hyperthyroidism. Results: A 48-year-old male presented to the emergency room with a 2-day history of palpitation, chest discomfort and 30 pounds of weight loss. Examination was remarkable for rapid and irregular pulse, diffuse thyromegaly and brisk deep tendon reflexes but no eye changes or tremors. Laboratory tests showed thyroid-stimulating hormone (TSH) of 20 (1.8–4.7 pg/ml), total thyroxine >800 (80–200 ng/dl). Electrocardiogram showed atrial fibrillation with rapid ventricular response. RAI uptake and scan showed a homogenous gland with 54% uptake in 6 h and 45% in 24 h. He was treated with propranolol and propylthiouracil with some clinical improvement. He subsequently underwent RAI therapy and developed hypothyroidism after 8 weeks. Hypothyroidism was treated with levothyroxine. At 2 years after RAI ablation, he again developed symptoms of hyperthyroidism and had suppressed TSH. The levothyroxine dose was stopped, 3 weeks after discontinuing levothyroxine, he remained hyperthyroid with TSH of 0.008 and FT4 of 1.62 and FT3 of 4.8. RAI uptake demonstrated 17% uptake at 24 h. Conclusion: Recurrent hyperthyroidism in GD is uncommon after development of post-ablative hypothyroidism. Our case illustrates the need for continued surveillance

Land Tenure Security and Resident’s Stability in Squatter Settlements of Lahore

Squatters have now become integral part of urban centers in most developing countries like Pakistan, with Lahore experiencing growth of such informal settlements at its peak. A myriad of issues and challenges associated with economic, social, spatial, environmental and political contexts within squatters has become a great hindrance towards home improvement and better life style. Tenure security brings a sense of homeownership to socioeconomically disadvantaged households. Recently, promotion of increased security of tenure of all whether living in formal or informal settlements has been affirmed by New Urban Agenda of Habitat III. Therefore, it is need of the time to look into present tenure types of squatters being offered by the city to solve problem of housing backlog and to provide promote inclusivity ensuring healthy, affordable and sustainable environment for all inhabitants.Proposed argument has got stronger foundation due to comparative analysis of squatter having secured land tenure with squatter of unsecure tenure. In this paper we explore that tenure security is one of the key factors which leads to resident’s stability, through case study approach by investigating two squatters based on their tenure types. The data collected through questionnaire will help us to identify other key factors associated with resident stability in squatters. Study reveals that limited secured tenure options and poor governance in present urban scenario projects as major obstacles in coping with urban sprawl and squatter settlements. Findings help us to understand the phenomena of inter-connection of land tenure security and residential stability of squatters in Lahore, suffering from housing shortage and informal settlements

Prevalence and severity of temporomandibular joint disorders among house officers & post-graduate residents of private & public sector medical hospitals in Peshawar, Pakistan

OBJECTIVES:To evaluate the prevalence and severity of TMDs in house officers and postgraduate students belonging to public and private sector medical and dental colleges.METHODOLOGY:This was a cross sectional study carried out from July 2018 to September 2018 in Department of Oral and Maxillofacial Surgery, Sardar Begum Dental College and Hospital, Peshawar. After approval from ethical committee Gandhara University, an informed consent was obtained and Fonseca questionnaire was used to evaluate TMDs from 320 subjects who voluntarily want to participate in the study; selected with equal genders from public and private sectors medical and dental hospitals, Peshawar. Those who have musculoskeletal, neurological, systemic problems and orthodontics treatment subjects were excluded from the study.RESULTS:The age range selected was 22-32 years and the mean age presentation was 26.5 ± 3.4 years. Results showed that female postgraduate residents of private sector consider themselves tenser (18.8%) than others. 70.17% female house officers of private sector have noticed TMJ clicking and 83.17% of male house officers clenched or grind their teeth than others.CONCLUSION:The study concluded that mild and moderate TMDs are more common in-house officers and postgraduate residents.KEYWORDS: Temporomandibular Disorders, Prevalence, Temporomandibular Joint, Fonseca’s Anamnestic Index, Cross-Sectional Stud

Evidence of zoonotic transmission of VP6 and NSP4 genes into human species A rotaviruses isolated in Pakistan in 2010

Introduction of animal group A rotavirus (RVA) gene segments into the human RVA population is a major factor shaping the genetic landscape of human RVA strains. The VP6 and NSP4 genes of 74 G/P-genotyped RVA isolates collected in Rawalpindi during 2010 were analyzed, revealing the presence of VP6 genotypes I1 (60.8%) and I2 (39.2%) and NSP4 genotypes E1 (60.8%), E2 (28.3%) and E-untypable (10.8%) among the circulating human RVA strains. The typical human RVA combinations I1E1 and I2E2 were found in 59.4% and 24.3% of the cases, respectively, whereas 5.4% of the RVA strains were reassortants, i.e., either I1E2 or I2E1. The phylogeny of the NSP4 gene showed that one G2P[4] and two G1P[6] RVA strains clustered with porcine E1 RVA strains or RVA strains that were considered to be (partially) of porcine origin. In addition, the NSP4 gene segment of the unusual human G6P[1] RVA strains clustered closely with bovine E2 RVA strains, further strengthening the hypothesis of an interspecies transmission event. The study further demonstrates the role of genomic re-assortment and the involvement of interspecies transmission in the evolution of human RVA strains. The VP6 and NSP4 nucleotide sequences analyzed in the study received the GenBank accession numbers KC846908- KC846971 and KC846972-KC847037, respectively.status: publishe

Biological and Physicochemical Characterization of Self-Adhesive Protective Coating Dental Restorative Material after Incorporation of Antibacterial Nanoparticles

This study evaluated the physicochemical and antibacterial properties of EQUIATM coat liquid (E) after incorporation of zinc oxide (ZnO) and titanium dioxide (TiO2) nanoparticles. ZnO and TiO2 (1 wt.% and 2 wt.%) were dispersed in EQUIA coat. Principal component analysis (PCA) and cluster analysis were performed to visualize systemic variation. Antibacterial activity was evaluated by colony-forming units and crystal violet staining using Streptococcusmutans and Lactobacillusacidophilus after 24 h, 48 h, and 72 h, and the microstructure was studied by scanning electron microscopy. The weight change was analyzed at 1 and 21 days. The PCA for TiO2- and ZnO-based groups showed 100% variance at all spectral ranges at 600&ndash;800/cm and 800&ndash;1200/cm, whereas 1200&ndash;1800/cm and 2700&ndash;3800/cm spectral regions demonstrated 99% variance. The absorbance values were significant (p &lt; 0.05) for both nanoparticles-based adhesives, and the specimens with 2 wt.% ZnO showed the maximum response by minimum bacterial attachment, and the control group showed the least response by maximum attachment. The weight change percentage was reduced after the incorporation of antibacterial nanoparticles. It is suggested that EQUIATM coat containing nanoparticles exhibits promising results, and it may be recommended to clinically use as an improved coating material